ISP Newsletter Editorials – 2010

May

ISP regularly receives the YoungMinds magazine . The latest issue has some particularly good articles in it. The one I especially like is “Scaled-down Approach” by Derren Hayes. It is about the work of James Wetz, a retired headteacher, who has committed his life to researching why, during a period when increasing numbers of young people are getting top marks in GCSEs, the gap between those who achieve academically and those who don’t is widening. In 2006 he wrote a report “Holding Children in Mind over Time” which concluded there is a compelling case to reconsider the design and organisation of secondary schools if we are to help the most vulnerable young people. His ideas culminated in working with architects to draw up blueprints for an urban village school underpinned by an ethos of developing and sustaining relationships, the concept for which is detailed in his book, “Urban Village Schools”, published in late 2009.

The urban village school model emphasises intimacy over anonymity; gives teachers the ability to work more closely with pupils; gets families more involved in school life; encourages a more in-depth approach to learning which is supported by continuous and varied performance assessment; and enables closer links with local businesses, people and other schools. “Every conversation a teacher has with a child is important, and understanding that children learn through relationships is a key design principle for the organisation of the urban village school”, explains Wetz.

Another key feature of Wetz’s model is that it’s underpinned by a theoretical framework based in attachment theory. This influences every aspect of the organisation and design of the school, from the inclusion of outside space to grow food, to attachment workers based on site to work with pupils and their families.

Wetz explains: “The human scale setting will allow teachers to be supported and resourced in time and in their training to provide a holding environment and secure base in relationships for pupils coping with difficulties and anxiety. Anxiety is an unavoidable part of learning and development but so often in our schools it threatens to overwhelm some of our young people. This model of school will act as a ‘container for anxiety’ to moderate stress, and soothe and support young people in regulating their emotions.”

Teachers would also be trained in attachment theory and child development supported by professional supervision and greater emphasis placed on enhancing pupils’ emotional abilities. The approach would also be used to tackle problem behaviour and resolve disputes.

Wetz says, “In this model teachers take time to discuss children’s needs with psychotherapists and thinking about how best to respond to their behaviour and find new ways to engage them in learning. Crucially I’m suggesting schools use the same language, discourse and theoretical framework that informs CAMHS. A lot of teaching is based in managing children but very little about attachment or getting to know children. Teachers should be trained in child development and if we don’t start doing this we’re missing a real opportunity to support children.”

It seems to me that the ISP School fits very closely to this model of the urban village school and we could very easily complete the missing bits of the jigsaw if we wish to do so. I hope we do.

I would like to end with a lovely description of a transitional object (a comforter) from an unlikely source. On the 1st May, Bear Grylls (the guy who does the survival shows on TV) was interviewed in the Independent Magazine. This is the relevant extract.

“My favourite item of clothing is an old, holey, woollen jumper which was my grandfather’s. He was a best friend to me growing up, a giant of a man; the jumper’s huge and still smells of him.”

June

Recently, while driving from Gloucestershire to Sittingbourne on a Monday morning, I was listening to the radio 4 programme “Start the Week”. On the panel being interviewed by Andrew Marr was the clinical psychologist Dorothy Rowe. She was talking about her recently published book, “Why We Lie”. It was a fascinating discussion and as soon as I could I jotted down some of the points she made.

• No two people ever see anything in exactly the same way, which is why misunderstanding occurs and why communication is never straight forward. You may think you’ve explained something absolutely clearly but it will be heard differently, more or less.
• We each live in our own world of meaning, which is a lonely place to be. It is difficult to communicate with other people. Other people misunderstand us. We misunderstand them.
• We produce a comforting fictional narrative (a story) to get us through this reality.
• To be accused of lying is an attack on one’s own sense of oneself and can lead to feelings of panic.
• The whole process of therapy is to help people identify the lies they have been telling themselves since they were small children and confront those lies and the truth that they are concealing. That is why people fear therapy and don’t want to go into it. They don’t want to face the parts of their lives that were horrible.

I must read the book. For me it is important that ISP doesn’t believe its own propaganda and tries to stay in touch with the reality of our experience and learn from it. That includes acknowledging mistakes and deficiencies. I guess to do that as an organisation we have to be prepared to do it ourselves as individuals. It is a tough ask but rewarding in the end.

I periodically add papers to my website. Most recently I have been reading a paper written in 1967 about play, “Play as Therapy in Child Care” by Barbara Dockar-Drysdale. Here is an extract:-

“People working in residential places sometimes tell me that they have very little time to play with the children in their care. There are many practical tasks to be fitted into the day: physical care, administration, maintenance, cooking, mending and so on. Often they say to me, “If only there was just a short time when we could just play with the children.” Listening to them, I get the impression that playing with children is regarded as a luxury which they cannot afford – an extra rather than an essential factor. I am quite sure that a planned play group, at a given time in a given place, would not only be valuable but essential.”

August

I attended Leslie Ironside’s three hour workshop on “The Effects of Trauma, Abuse and Neglect on Child Development and Attachment”. Leslie is the Consultant Child and Adolescent Psychotherapist who works with the staff team at ISP Sussex so I was particularly looking forward to this workshop and it didn’t disappoint. Leslie talked about “therapeutic management” and this is an extract from his paper, “Living a Provisional Existence”, which can be found on ISP’s website.

“…I find it helpful to encourage the foster carers to see the behaviour in terms of infant development and regressed states of being rather than as seeing the child as being either “mad” or “bad”. Returning to a physiological model, it is important to remember that at birth the infant is remarkably ill-equipped to cope with the variations and excitations of its new environment. The infant is a delicate creature who is in danger of going into shock through overreacting to powerful or unexpected stimuli because he or she lacks the means for modulation of behaviour that is made possible by the later development of emotional control. This emphasises the essential role of the carer who modulates the child’s overwhelming emotions and acts as his or her ‘auxiliary brain’. Likewise, foster carers may need to play the role of the auxiliary brain but this is a much more challenging, if sometimes impossible, task with older traumatised children. In addition, a reminder of the familiar state of tantrums and the terrible twos, but within a now older child, can begin to encapsulate the experience and allow it to become more tolerable.

This leads to different styles of management more in keeping with parenting a younger child that can sometimes be incredibly helpful. For instance, it can be useful to follow a style of interaction, such as, “Let’s go and hang our coats up” rather than “Go and hang your coat up”. The latter is important for an older and securely attached child but it is a quite different style of parenting that implies separation and independence. In my direct work with foster carers I also naturally use similar language, for instance, saying “Let’s think about this together”. This indicates an important commitment to a shared task in which we are both trying to find a solution to the presenting issues.”

September

I have come across a couple of websites that I would like to draw your attention to: www.goodenoughcaring.com and www.childrenwebmag.com

You can sign up to receive the Children Webmag, which appears monthly, for no cost. Goodenoughcaring.com is a website where you can access a variety of papers and articles about social care. One of the articles I found is “On becoming and being a foster carer” by Shanna Marrinan. Here is an extract:

“I was recently asked two pertinent questions; what are the greatest challenges in fostering and what makes a good foster carer? While these are both huge questions that could never be fully answered here (if anywhere) I do have a couple of thoughts. I think for me personally the challenges depend on the child, and are innumerable, but so are the rewards. I have previously said that one difficult aspect for me was accepting that not everything can be solved, and not all behaviours have neat explanations and answers, but saying that, sometimes, especially with younger children, you can see vast improvements and that’s very fulfilling. Another big one would have to be the devastating impact on your social life – Fostering is truly a 24-hour ‘job’ and trustworthy (available!) babysitters are a must from time to time.

As for what makes a good foster carer, perhaps the children themselves have the most important perspective on that – certainly adults seem to have difficulty agreeing on the best way to do things when it comes to all things child-related! Although there are things that are universally accepted as not ok, the ‘best’ way is another story! Dealing with fussy eaters, or attention-seeking tantrums, or teenagers that won’t get out of bed, are just some of the areas foster carers can widely differ on, but often no one approach is ‘better’ than another and a course of action that works wonders with one child can cause uproar with another. I certainly have my own preferences and ‘tactics’ but when it comes to those of others I understand that I probably don’t understand, and try to stick by ‘if you can’t say anything nice don’t say anything at all’.

October

At the beginning of October I went to Leeds to present a paper at a conference hosted by the Northern School of Child and Adolescent Psychotherapy. It was a conference primarily attended by residential child care workers and managers so I was a bit apprehensive about delivering my message that therapeutic fostering has many advantages over institutional care.

This is an extract from my paper:

“Making relationships is surely one of the most important elements in human development. Institutional child care has, on the whole, failed pretty miserably in helping young people develop this capacity.

Therapeutic child care (whether in a therapeutic community or foster family) must encourage the capacity to make relationships. We know that the capacity to develop lasting and meaningful relationships develop in accordance with the opportunity of the child, especially the very young child, to form secure attachments. The good ordinary family provides an excellent opportunity for the young child to form a focal, intense attachment. He forms other important, although less intense, attachments with others in the family and gradually his attachment circle extends, as he grows older. Moreover, the people in his circle of attachment also have attachments to each other which are important to him for identification. He not only loves his mother as he experiences her, but identifies with his father loving his mother and extends his concept of the male loving the female (and vice versa). For the most part, institutions have dismally failed to replicate that pattern. This was certainly true of larger institutions in which all staff indiscriminately cared for all the children, preventing child/adult attachments.

Foster families, it seems to me, are in a much better position to encourage the making of relationships. One of the reasons I decided to leave the Cotswold Community was the pressure to reduce the working week for staff which I thought would undermine the emotionally unintegrated child’s need for continuity of care. These children haven’t achieved sufficient ego strength to cope with long absences of their main attachment figures. I see foster families being able to offer this continuity of care.”

Over the last few weeks I have been enjoying a book about the life and work of Clare Winnicott “Face to Face with Children” by Joel Kanter. Clare married the more famous Donald. They met when she was a Social Worker in Oxfordshire and responsible for several hostels for evacuated children (during the war years) who had too many problems to live with local families. Donald Winnicott travelled from London once a week to advise the hostels. She later ran the Social Work training course at the LSE and trained as a psychoanalyst. Unfortunately she didn’t write that much but what she did I have found really accessible. A third of the book is a biography written by Joel Kanter. He says:

“What makes her writings interesting to us today is that, unlike many of her psychoanalytic contemporaries she did not reify any particular psychoanalytic construct – such as transference interpretations – as a route towards successful therapy. She was, rather, interested in the psychoanalytic process, and how it can help people towards authenticity and a sense of self. For her establishing a therapeutic conversation was what mattered, not what the content of that conversation happened to be. She saw that the moment a child can communicate in words something of his inner world, a foothold has been established. Recovery flows from speaking the truth about feelings and being sensitively heard, not judged, organised, or advised. And, of course, it is the possibility of being heard that is the catalyst that allows the feelings to flow and the words to form.”

Clare Winnicott encountered evacuated children who had shutdown their feelings of terrible loss and she believed it was essential to understand and acknowledge the objective reality of children’s losses and traumas in order to help them to achieve the goal of successful maturation. This is how she put it:

“….our real aim is to keep children alive…..By keeping children alive I am of course referring to maintaining their capacity to feel. If there are no feelings, there is no life, there is merely existence. All children who come our way have been through painful experiences of one kind or another, and this has led many of them to clamp down on feelings and others of them to feel angry and hostile, because this is more tolerable than loss and isolation.

Our work, therefore, is not easy because it will lead us to seek contact with the suffering part of each child, because locked up in the suffering is each one’s potential for living and for feeling love as well as feeling hate and anger. To feel a sense of loss implies that something of value, something loved, is lost, otherwise there would be no loss. Awareness of loss therefore restores the value of that which is lost, and can lead in time to a reinstatement of the lost person and loving feelings in the inner world of the child. When this happens, real memories, as opposed to fantasies, of good past experiences can come flooding back and can be used to counteract the disappointments and frustrations which are also part of the past. In this way, the past can become meaningful again.”

This was written 46 years ago and is still relevant today, in my opinion.

December

We set out our stall as providing therapeutic fostering. What does this mean? We have to be able to articulate what it means and more importantly we have to do it.
Therapeutic fostering is not ordinary fostering with a bit of therapy bolted on. There are several agencies that are doing this and trying to claim their work is therapeutic. If you have attended our training on “therapeutic child care” you would have heard me liken our work to gardening i.e., preparing the conditions for growth. What is the fostering equivalent of good quality soil, the right amount of sunshine, enough rainfall, appropriate shelter, which for plants leads to growth, and if they are damaged, recovery and growth? Gardeners know that different varieties of plants and flowers need different combinations of the above. Some need a really sheltered environment, like a greenhouse, to get started before they are strong enough to be exposed to the elements.

Therapeutic child care requires us to get to know the child as an individual and to figure out how to create the conditions for growth for him/her. We might know some theories and principles that we can draw on to help, just like the gardener, but essentially we need to get to know this particular child. This isn’t just a superficial getting to know but comes about through a deep preoccupation with him/her, really getting inside his/her shoes and seeing the world as he/she does. This is what we mean by empathy, which is very different to sympathy, a more sentimental emotion. Clearly carers are in the best position to feel empathy for the young people in their care. This is why carers are central to the therapeutic process in therapeutic fostering, or therapeutic parenting if you prefer. In the 1950s Bruno Bettelheim wrote “Love is not Enough”, a book which described the characteristics of a therapeutic living environment needed to help children who had been emotionally and physically traumatised. As the title suggests good quality care by itself won’t be enough for our young people.

Christmas is an important time for getting inside the shoes of children. We need to know if instead of it being a time of pleasure and excitement it is full of dread and bad memories. The period before Christmas can be especially tense for some children as they anticipate another year of disappointment and dashed hopes. As our families look forward to the festivities we need to be alert to the young people in our care who will not see it like that and who may not be able to join in, not because they are being deliberately awkward, but because of the reawakening of painful memories.